RESUMO
BACKGROUND AND OBJECTIVE: Advancing an uncut endotracheal tube into the right main bronchus produces unilateral breath sounds. We wanted to test the validity of using this method to distinguish oesophageal from tracheal intubation. METHODS: Forty-two patients were randomized into two groups. The first group was randomized to receive an endotracheal tube that was advanced into the right main bronchus. The second group of patients had their tracheas intubated as normal and then a second endotracheal tube was placed in the oesophagus. Blinded observers were then asked to decide by auscultation if the patients had unilateral breath sounds or not and if they were bronchial and therefore to decide if endotracheal intubation had occurred. RESULTS: Ninety-one per cent of patients (95% CI 0.71-0.99) intubated in the right main bronchus were correctly identified by unilateral breath sounds confirming the usefulness of this test. CONCLUSIONS: Advancing an endotracheal tube into the right main bronchus and auscultation of unilateral breath sounds is a useful way of confirming tracheal intubation.
Assuntos
Capnografia , Intubação Intratraqueal/métodos , Adolescente , Adulto , Idoso , Auscultação , Brônquios , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
The management of six awake, spontaneously breathing patients with acute severe asthma who responded to a subanesthetic dose of an inhalational agent is described. All of these patients were on maximal medical treatment, the next intervention likely to be tracheal intubation and mechanical ventilation in the face of further deterioration. All six patients initially responded dramatically, although one required mechanical ventilation after initial response.
Assuntos
Anestésicos Inalatórios/uso terapêutico , Asma/tratamento farmacológico , Espasmo Brônquico/tratamento farmacológico , Halotano/uso terapêutico , Éteres Metílicos/uso terapêutico , Anestésicos Inalatórios/administração & dosagem , Halotano/administração & dosagem , Frequência Cardíaca/efeitos dos fármacos , Humanos , Éteres Metílicos/administração & dosagem , Respiração/efeitos dos fármacos , SevofluranoAssuntos
Asma/fisiopatologia , Pulso Arterial , Doença Aguda , Adulto , Humanos , Monitorização Fisiológica/métodosRESUMO
A 41-year-old woman was admitted to the Intensive Care Unit with a severe exacerbation of asthma. She was exhausted despite maximal standard medical treatment. Instead of tracheal intubation and mechanical ventilation a subanaesthetic dose of halothane was delivered in 100% oxygen using a close-fitting face mask. Her bronchospasm resolved within minutes. The argument for using inhaled halothane to avoid tracheal intubation, mechanical ventilation and their side-effects is presented.
